MEDICARE: CARLA BOEREE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1699485763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLA BOEREE

Provider Business Mailing Address
First Line	:	1060 GARDINER DR
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-6314
Country	:	US
Telephone Number	:	631-206-4669
Fax Number	:

Provider Business Practice Location Address
First Line	:	1060 GARDINER DR
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-6314
Country	:	US
Telephone Number	:	631-206-4669
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2022
Last Update Date	:	11/30/2022

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Directions to “ CARLA BOEREE ” Practice Location

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